Provider Demographics
NPI:1548285315
Name:JUGUILON, CHRISTINA ORTIZ (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:ORTIZ
Last Name:JUGUILON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:145 MAIN ST
Mailing Address - Street 2:REVITALIZING PSYCHIATRY
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8107
Mailing Address - Country:US
Mailing Address - Phone:201-488-5161
Mailing Address - Fax:201-488-5162
Practice Address - Street 1:145 MAIN ST
Practice Address - Street 2:REVITALIZING PSYCHIATRY
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8107
Practice Address - Country:US
Practice Address - Phone:201-488-5161
Practice Address - Fax:201-488-5162
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052666001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical